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Finals Studying - Condensed > Renal > Flashcards

Renal Flashcards

1
Q

nephrotic synd

A

proteinuria
hypoalbuminaemia
oedema

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2
Q

nephritic synd

A

haematuria

HTN

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3
Q

causes of a nephrotic syndrome

A

mimimal change disease
focal segmental glomerulosclerosis
membranous glomerulonephritis

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4
Q

minimal change disease

A

nephrotic picture

commonest cause in children

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5
Q

focal segmental glomerulosclerosis

A

nephrotic picture

commonest cause in adults

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6
Q

causes of focal segmental glomerulosclerosis

A

idiopathic
HIV
heroin

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7
Q

membranous glomerulonephritis

A

nephrotic picture

2nd commonest cause in adults

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8
Q

causes of membranous glomerulonephritis

A

infections
rheumatoid drugs
malignancy

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9
Q

rule of 1/3 in membranous glomerulonephritis

A

1/3 resolve
1/3 resolve to cytotoxics
1/3 develop CKD

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10
Q

causes of a mixed nephritic/nephrotic syndrome

A

diffuse proliferative glomerulonephritis

membranoproliferative glomerulonephritis

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11
Q

diffuse proliferative glomerulonephritis

A
  • mixed nephritic/nephrotic syndrome

post-strep infection in a child (1-2 w later)

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12
Q

membranoproliferative glomerulonephritis

A
  • mixed nephritic/nephrotic syndrome
    type 1: cryoglobulinaemia (hep C)
    type 2: partial lipodystrophy
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13
Q

causes of a nephritic syndrome

A

rapidly progressive glomerulonephritis

IgA nephropathy

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14
Q

rapidly progressive glomerulonephritis

A
  • nephritic syndrome

aggressive and can cause ESRF in a few days

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15
Q

causes of rapidly progressive glomerulonephritis

A

goodpastures syndrome (anti GBM disease)

  • autoantibodies to type iv collagen
  • causes pulmonary haemorrhage and rapidly progressive glomerulonephritis
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16
Q

Mx rapidly progressive glomerulonephritis

A

aggressive immunosuppression - high dose IV steroids and cyclophosphamide

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17
Q

where do carbonic anhydrase inhibitors work

A

the proximal convoluting tubule

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18
Q

mode of action of carbonic anhydrase inhibitors

A

facilitate Na/H exchange in the PCT

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19
Q

example of an osmotic diuretic

A

mannitol

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20
Q

where do osmotic diuretics work

A

PCT and the thin loop of Henle

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21
Q

mode of action of osmotic diuretics

A

they stay in the filtrate and inhibit the reabsorption of water to maintain urine output

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22
Q

examples of loop diuretics

A

furosemide, bumetanide

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23
Q

where do loop diuretics work

A

ascending loop of henle

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24
Q

mode of action of loop diuretics

A

block Na/K/Cl triple transporter

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25
Q

where do thiazide diuretics work

A

distal convoluting tubule

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26
Q

example of thiazide diuretic

A

bendroflumethiazide

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27
Q

mode of action of thiazide diuretics

A

block Na/Cl transporter

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28
Q

where do aldosterone antagonists work

A

cortical collecting tubule

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29
Q

example of aldosterone antagonist

A

spironolactone

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30
Q

s/e of spironolactone

A

hyperkalaemia

gynaecomastia

31
Q

definition of AKI

A
  1. absolute increase in creatinine by >26.4 micromol/L
  2. increase in creatinine by >50%
  3. reduction in urine output (<0.5 ml/kg/h)
32
Q

nephrotoxic drugs

A

ACEi
NSAIDs
aminoglycosides (e.g. gentamicin)
diuretics

33
Q

presentation of AKI

A 
reduced urine output 
fluid overload 
rise in K, urea, creatinine 
arrhythmias 
features of uraemia - pericarditis, encephalopathy
34
Q

what is a ‘pre-renal’ AKI

A

ischaemia or lack of blood for to the kidneys

35
Q

pre-renal causes of AKI

A

hypovolaemia
renal artery stenosis
hypotension

36
Q

what is a ‘renal’ AKI

A

intrinsic damage to the glomeruli, renal tubules or kidneys themselves

37
Q

renal causes of AKI

A

glomerulonephritis
acute interstitial nephritis
acute tubular necrosis
rhabdomyolysis

38
Q

what is a ‘post-renal’ AKI

A

obstruction to the urine coming out of the kidneys

39
Q

post-renal causes of AKI

A

kidney stones
BPH
bladder/cervical/prostate ca

40
Q

Ix of AKI

A

urinalysis +/- MSU
venous blood gas
ECG
renal USS

41
Q

Mx AKI

A

Fluids!!!
stop any nephrotoxic drugs
Mx of hyperkalaemia if persistent

42
Q

mild hyperkalaemia Mx

A

(5.5 - 6)

calcium resonium - binds to K

43
Q

moderate hyperkalaemia Mx

A

(6 6.5)

insulin/dextrose infusion

44
Q

severe hyperkalaemia Mx

A

(>6.5)

(any ECG changes) - IV calcium gluconate

45
Q

IgA nephropathy presentation

A
  • nephritic syndrome

young man presenting a couple of days after URTI with episodic macroscopic haematuria

46
Q

Mx IgA nephropathy

A

supportive!

steroids shown not to be effective

47
Q

commonest cause of glomerulonephritis

A

IgA nephropathy

48
Q

what is acute interstitial nephritis

A

renal inflammation localised to the renal interstitium

49
Q

the main cause of acute interstitial nephritis

A

DRUGS!!!!

  • NSAIDs
  • allopurinol
  • furosemide
  • penicillin
  • rifampicin
50
Q

presentation of acute interstitial nephritis

A 
mild renal impairment 
fever 
rash 
arthralgia 
eosinophilia
HTN
51
Q

Ix acute interstitial nephritis

A

bloods - U&Es

+/- renal biopsy

52
Q

Mx acute interstitial nephritis

A
  1. stop offending medicine
  2. supportive - fluid and electrolyte balance
  3. steroids - if not resolving
53
Q

causes of acute tubular necrosis

A 
renal ischaemia (shock, sepsis) 
aminoglycosides
myoglobin (2 to rhabdo) 
uric acid (2 to gout) 
light chain proteins (2 to myeloma)
54
Q

presentation of acute tubular necrosis

A

features of AKI

“muddy brown casts” in urine

55
Q

Mx acute tubular necrosis

A

supportive - fluid and electrolyte balance

56
Q

Mx rhabdomyolysis

A

IV fluids

+/- urinary alkalinisation (IV sodium bicarb)

57
Q

main causes of CKD

A 
diabetic nephropathy 
chronic glomerulonephritis 
chronic pyelonephritis 
HTN 
polycystic kidneys
58
Q

stage 1 CKD

A

normal eGFR > 90 ml/min

signs of kidney damage on other tests

59
Q

stage 2 CKD

A

eGFR 60-90 ml/min

signs of kidney damage on other tests

60
Q

stage 3a CKD

A

eGFR 45-59 ml/min

61
Q

stage 3b CKD

A

eGFR 30-44 ml/min

62
Q

stage 4 CKD

A

eGFR 15-29 ml/min

63
Q

stage 5 CKD

A

eGFR <15 ml/min

established kidney failure - dialysis or transplant needed

64
Q

types of dialysis

A

haemodialysis

peritoneal dialysis

65
Q

haemodialysis

A

arteriovenous fistula

- takes 6w to mature

66
Q

peritoneal dialysis

A

solute is remvoed across the peritoneal membrane

Continuous Ambulatory Peritoneal Dialysis (4 bags/day)
or
Automated Peritoneal Dialysis (1 bag/day)

67
Q

Mx of CKD

A

limit disease progression

BP reduction - ACEi or ARB
Renal bone disease - Alfacaldiol or Phosphate binders
CVS - statin
Anaemia of Chronic disease - IV iron or erythropoietin injection

68
Q

presentation of ADPKD

A 
HTN 
recurrent UTIs 
renal stones 
haematuria 
CKD
69
Q

extra-renal manifestations of ADPKD

A

liver cysts
berry aneuryms
mitral valve prolaspe
cysts in other organs

70
Q

Ix ADPKD

A
  1. renal US
  2. CT abdo/pelvis
  3. Genetic testing
71
Q

Mx ADPKD

A

symptomatic Tx - complications as they arise

72
Q

Screening test for relatives of ADPKD

A

abdo US

73
Q

presentation autosomal recessive ADPKD

A

renal masses & renal failure detected on prenatal US

ESRF develop in childhood

Finals Studying - Condensed (22 decks)

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